Organization
MY PEACE KEEPER II INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGINIA POUGH (DIRECTOR OF OPERATION)
(980) 505-0902
Entity
Organization
Contact information
Practice address
3119 SPRING GLEN RD STE 104, JACKSONVILLE, FL 32207-5921
(980) 505-0902
(704) 919-5055
Mailing address
3119 SPRING GLEN RD STE 104, JACKSONVILLE, FL 32207-5921
(980) 505-0902
(704) 919-5055
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
08/18/2017
Last updated
07/21/2022
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